Lung transplantation comes of age

Article Abstract:

Lung transplantation is now a clinically acceptable procedure. Transplants are performed involving the heart and lungs, one lung, or both lungs and the entire bronchial tree. The single-lung approach is indicated for people with normal cardiac function but severe pulmonary fibrosis, a condition where lung tissue has been supplanted by fibrous connective tissue. Problems with lung transplantation remain, however. One concerns the availability of healthy, functioning lungs for transplantation; many critically ill patients who are would-be donors are given large volumes of fluid to increase blood supply, but this ultimately floods the lungs and makes them ineligible for donation. The lung can be maintained no longer than four hours and recipients must live within two and one-half hours' travel time to the hospital. Currently, about one-fourth of the patients waiting for a lung die before a donor is found. Mechanical problems, such as bleeding, affect the lung after transplantation and it is subject to infection during the period of immunosuppression that follows all organ transplantation. After six months, rejection has usually ceased to be a problem; however, severe obstructive lung disease may develop during this period. The condition can be detected and treated if diagnosed early enough. Patients should be considered for lung transplantation if they need it and are well and courageous enough to survive the surgery and the postoperative period. The procedure is expensive ($240,000 for initial care, and an additional $47,000 per year for medication and care) and often not reimbursed by insurance companies. Still, lung transplantation has a future. Since 1986, survival rates are 70 percent for one year, 66 percent for two years, and 60 percent for three years. Improved methods of immunosuppression and organ preservation may lead to an increase in the frequency of this procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lungs, Lung transplantation, editorial

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Renal transplantation in children: a report of the North American Pediatric Renal Transplant Cooperative Study

Article Abstract:

Children who receive a donated kidney from a living relative may be more likely to have a successful graft than those who receive the organ from a cadaver. A review of data on 1,667 kidney transplants from 73 pediatric transplantation centers in the US and Canada between 1987 and 1990 found that the most common causes of kidney failure requiring a transplant in children were congenital malformations of the kidneys and urinary tract and focal glomerulosclerosis. One year after transplantation, graft survival was 89% in the children who received a relative's kidney compared to 74% in those who received a cadaver's kidney. At three years, graft survival was 80% in children who received a relative's kidney and 62% in those who received a cadaver's kidney. At the time of the transplant, all the children were below the standard height for their age, and only the children younger than five years of age grew substantially after the transplant. Seventy-nine children died after receiving the transplant, and almost half died from infection.

Kidneys, Kidney transplantation

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Cord-blood transplantation from an unrelated donor in an adult with chronic myelogenous leukemia

Article Abstract:

Stem cells from umbilical cord blood may be effective in treating leukemia in adults if a suitable bone marrow donor cannot be found. Stem cell transplants have been used in children but very few adults. A 26-year-old woman received a stem cell transplant after chemotherapy failed to control her leukemia. Her physicians were also unable to find a compatible bone marrow donor. The stem cells completely reconstituted her immune system and a chromosome abnormality characteristic of leukemia disappeared. The woman was able to return to work, but long-term follow-up will be needed to determine if she has been cured.

Health aspects, Care and treatment, Stem cells, Chronic myeloid leukemia

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